Hospitals insisting on cesarean sections contrary to the mother's wishes

I'm concerned at an apparent erosion of patient choice in many aspects of medicine due to managed care plans and associated cost-cutting, and liability risks to physicians and hospitals. Here's an interesting example of it... I've snipped some parts of the article, fyi.

'Once a C-section, always a C-section' ringing truer
By Denise Grady, NEW YORK TIMES

The notice, posted in her obstetrician's office in Lancaster came as a shock to Danell Freeman: The local hospital would no longer allow doctors to deliver babies vaginally for women who, like her, previously had had a Caesarean section.

Unless she changed doctors and hospitals, Freeman would have to have another Caesarean, something she had hoped to avoid...

"I don't like the idea of being cut open again," she said.

...The rate of vaginal births in women who have had Caesareans has fallen by more than half, to 10.6 percent in 2003 from 28.3 percent in 1996. About 300,000 women a year have repeat Caesareans.

Major medical centers still perform such deliveries, but many smaller ones have banned the practice, saying that it is riskier than once thought and that they do not have the staff to handle emergencies that may arise.

Obstetricians estimate there is about a 1 percent chance that the Caesarean scar will cause the uterus to rupture during a subsequent labor, which can cause dangerous blood loss in the mother and brain damage or death in the baby.

A decade ago, the risk of rupture was thought to be 0.5 percent or less. The percentage of babies injured after a rupture is not known but is thought to be low.

Many women are willing to take the risk, and the hospitals' stance has become a charged issue, part of a larger battle over who controls childbirth.

Some women say their freedom of choice is being steamrolled by obstetricians who find Caesareans more lucrative and convenient than waiting out the normal course of labor. Doctors say their position is based on concern for patients' safety.

On a practical level, many women prefer vaginal birth because they recover more quickly and with less pain than they do from a Caesarean.

In addition, each Caesarean increases the risk of complications in the next pregnancy, so women who want more than two or three children often hope to avoid the operation.

...A study published in an obstetrical journal in 1997 found that when women with a previous Caesarean were offered a natural delivery, 30 percent to 50 percent wanted it.